NEW YORK (Reuters) – For the last few days, unease and paranoia have followed Ann Ostberg like a black cloud, as the coronavirus swept through the United States, reaching all 50 states by this week.

With state and local governments urging isolation to stem the spread of the highly contagious and sometimes deadly respiratory illness, the 62-year-old Nebraska woman worries she will not be able to provide emotional support for her daughter, whose husband is paralyzed with Guillain-Barre syndrome.

If someone were to infect her son-in-law with his weakened immune system, “he’d be dead,” Ostberg said.

Chicagoan Mike Wisler was prescribed a sedative to help him sleep when the financial and emotional impact of the pandemic hit the 50-year-old bartender. “My mind won’t shut off,” Wisler said. “As soon as I wake up, it’s like, ‘How am I going to get by this month?'”

With public gatherings banned, his work tending bar at parties and private events has evaporated.

In North Carolina, 23-year-old Niko, who asked that his last name not be used, is in recovery for drug addiction, and fears a relapse.

The grocery store clerk is suffering nervous ticks and bouts of reticence while trying to put on a brave face to avoid alarming shoppers. “What I’m worrying about in my head, I’m only showing about 20 percent of it,” he said.

Psychologists and psychiatrists are beginning to report signs of distress among patients worried about the consequences of the COVID-19 pandemic that has infected more than 14,500 nationwide, and over 255,000 globally, killing more than 10,000.

Six clinicians interviewed by Reuters say the coronavirus has been the prime focus of virtually all recent therapy sessions.

Stress caused by fear of the disease is compounded by isolation, mental health experts say, as governments close schools and restaurants, and recommend that people limit social interaction.

Stress-reducing activities like exercise, watching sports and going to movies, are becoming nearly impossible after shutdowns of gyms, professional leagues and theaters.

‘A BEAR WE CAN’T SEE’

The virus’ invisibility makes it all the harder to reconcile the severity of the response.

“We’re all a little disoriented,” said Sharon Greenfield, a clinical psychologist in Concord, Massachusetts.

“When we see a bear, we go straight into fight-or-flight, but this is a bear we can’t see or taste. Our brains aren’t quite sure whether we’re being exposed to a traumatic trigger or not.”

A Reuters/Ipsos poll this week showed 48% of Americans feel the pandemic is an “imminent threat” to the United States, up 20 percentage points from previous polling taken March 2-3.

Psychiatrists interviewed by Reuters cited surges in requests for new anti-anxiety prescriptions and longer refills on existing ones.

For mental health professionals, there is the challenge of providing much-needed care while following social distancing guidelines. That likely means seeing patients via video services.

But remote therapy, known as telehealth, isn’t covered by every insurance plan. Federal legislation enacted this month in response to the coronavirus eases restrictions on telehealth coverage under Medicare. Some states are also requiring private insurers to cover telehealth more broadly.

Most therapists, though, have not historically provided it. A 2018 study published in the American Psychological Association (APA) Journal showed nearly 60% of providers do no online counseling, and just 6% do more than five hours per week.

Since the outbreak took hold, people are scrambling to figure out how to do telehealth, said psychologist Lynn Bufka, director of practice research and policy at the APA.

Greenfield said the mental health impact of the coronavirus should warrant a coordinated response, and that federal and local leaders should have protocols for managing a mental health emergency as they do a physical one.

The U.S. Department of Health and Human Services had no comment when asked if coordinated plans exist.

The mental health of hospital and other healthcare workers, who risk increased exposure to the virus, is a rising concern.

The Facebook group “Covid19 for Healthcare Workers”, which had 124,000 members as of Friday, circulated online signup sheets for therapists willing to donate a free hour of care to such workers.

Volunteers “may be asked to provide some debriefing support, for the healthcare workers’ mental health needs during Covid-19,” the form said. Administrators for the group did not immediately respond to requests for comment on Friday.

COPING TOOLS

To manage anxiety, doctors recommend limiting news intake to once or twice a day, to stay abreast of health experts’ recommendations while avoiding over-exposure that can trigger panic.

They suggest watching comforting movies, video-chatting with family, and going outside as long as it does not conflict with health experts’ guidance.

“Connect more deeply with nature, since that is a safe space many of us have become too busy to enjoy,” said Charles Mobayed, a psychologist in Lunenburg, Massachusetts.

They also recommend acknowledging anxious thoughts, rather than repressing them – but then moving on quickly.

“Notice yourself starting to go there, and say, ‘I hear you, but I’m not gonna think about that right now,’” said Laura Dalheim, a psychiatrist in New York City, which has seen a big spike in coronavirus cases with increased testing.

Therapists who spend hours each day soothing the fears of others say they are not immune to the anxiety all around them.

Dalheim says she’s had to fight the urge to mirror her patients’ concern during sessions. Greenfield, after an exhausting week, said she found herself on her couch last Friday night eating cheese puffs – and in bed by 9:30.

It’s common for health workers to exhaust themselves in a crisis, and crucial they heed the same stress-management advice they provide, said psychologist Jacqueline Sperling, an instructor at Harvard Medical School.

“If you wear down your resources,” she said, “you have only an empty hand to give.”